Sehr geehrte Damen und Herren,
Fußballer der Spitzenklasse haben kaum noch Pausen. Die Saison in den Top-Ligen des Kontinents ist gerade mal vorbei, da sind die besten Spieler schon wieder bei der Europameisterschaft in Frankreich im Einsatz (10. Juni bis zum 10. Juli 2016). Verletzungen bleiben bei dieser Dauerbelastung nicht aus. Die Spieler müssen einerseits in bestem Gesundheits- und Trainingszustand sein, andererseits sollen sie aber bis zu 70 Spiele pro Jahr absolvieren. Welches Risiko Profis, Trainer und Vereine dabei eingehen und welche Möglichkeiten zur Prävention bleiben, beschreibt Prof. Dr. Jürgen Freiwald im GOTS-Newsletter.
Mit freundlichen Grüßen,
Ihr Andreas Bellinger, presse@gots.org
Nur noch wenige Tage bis zum 31. Jahreskongress der GOTS in München. Vom 16. bis 18. Juni 2016 laden Kongresspräsident Prof. Romain Seil und sein Team neben allen an der Sportorthopädie interessierten Medizinern, Physiotherapeuten, Sportwissenschaftlern und Studenten auch die Vertreter der Medien herzlich ins Hotel Leonardo am Olympiapark ein. Wenige Wochen vor den Olympischen und Paralympischen Spielen steht das vielfältige Programm im Zeichen der fünf Ringe. Führende Mediziner des Internationalen Olympischen Komitees (IOC) und der Fachverbände im Deutschen Olympischen Sportbund (DOSB) beantworten Fragen zu aktuellen Themen rund um die Wettbewerbe in Rio de Janeiro. Das wissenschaftliche Programm mit den dazugehörigen Zeittafeln finden Sie unter www.gots-kongress.org/wissenschaftliches-programm. Wer sich registrieren möchte, kann dies auf der Kongress-Website (www.gots-kongress.org/registrierung) tun.
Fußballer im Stress: Pausenloses Verletzungsrisiko
Es ist wieder soweit: Die besten Fußball-Teams des Kontinents bereiten sich auf die Europameisterschaft in Frankreich (10. Juni bis zum 10. Juli 2016) vor. Auch Weltmeister Deutschland hat sein Trainingslager bezogen – und das nur wenige Tage nach dem Ende der Bundesliga-Saison und des Pokalfinales, an dem viele Akteure der Nationalmannschaft beteiligt waren. Zwei Spieler, die auch während der EM Leistungsträger im Team von Bundestrainer Joachim Löw sein sollen, fehlten noch beim Auftakt in der Schweiz. Sie waren mit ihren Vereinen beim Pokalfinale in der Türkei (Lukas Podolski) beziehungsweise im Finale der Champions League (Toni Kroos) im Einsatz.
Durch den engen Terminplan und die hohen Turnierbelastungen muss der Trainings- und Gesundheitszustand der Spieler optimal sein; ansonsten werden sich auch bei den kommenden Europameisterschaften die Verletzungen häufen. Viele Spieler absolvieren mittlerweile pro Jahr bis zu 70 Spiele. Die Belastungen liegen an der Grenze der physischen und psychischen Leistungsfähigkeit. Aus den genannten Gründen ist ein geordnetes Mannschaftstraining mit gezieltem Leistungsaufbau – wenn überhaupt – nur noch unter erschwerten Bedingungen möglich.
Epidemiologie und Inzidenz von Verletzungen
Eine (Sport-)Verletzung beziehungsweise ein Sportunfall ist definiert als ein plötzliches und unerwartetes Ereignis, das durch exogene (Gegnereinwirkung) oder endogene Einwirkungen (eigene, nicht koordinierte Muskelkraft) zu einer Schädigung von Geweben führt [1]. Professionelle Fußballspieler erleiden je 1.000 Stunden Trainings ca. 2,49 bis 3,3 Verletzungen. Während 1.000 Stunden Spiels sind es ca. 21 Verletzungen [Übersicht in 2, 3].
Mit zunehmendem Alter nimmt die Verletzungsquote zu; professionelle Fußballspieler über 30 Jahre sind signifikant häufiger verletzt, insbesondere wenn schon vorher Verletzungen vorgelegen haben [4-6]. Während der großen Fußball-Turniere, die mit 24 (Europameisterschaft) beziehungsweise 32 Mannschaften (Weltmeisterschaft) in einer Gruppenphase mit anschließenden K.o.-Runden über vier Wochen gespielt werden, ist die Verletzungsquote gegenüber den Ligaspielen nochmals leicht erhöht [4, 5]. Nicht zuletzt, weil EM und WM an das Ende einer anstrengenden Saison anschließen.
Im Vordergrund der typischen Verletzungen im Fußball stehen die der Muskulatur, insbesondere der hinteren Oberschenkelmuskulatur, der Adduktoren, der Wade sowie Reizungen der Muskel-Sehnen- und Sehnen-Knochen-Übergänge am Schambein, Kniegelenk und an der Achillessehne. Es folgen die Kapsel-Bandtraumen am Knie- und Sprunggelenk; häufig verbunden mit Knochenödemen, Meniskusschäden und Knorpelschädigungen [4, 5, 7-12].
Bei der Europameisterschaft werden nicht nur die akuten Verletzungen häufig zu beobachten sein, sondern auch die Über- und Fehlbelastungen sowie Funktionsstörungen. Bei Überlastungen steht das chronische Überschreiten der Gewebstoleranz im Vordergrund; sie sind als Summation von Mikrotraumen bei nicht ausreichender Fähigkeit zur Anpassung zu werten. Fehlbelastungen bezeichnen das Missverhältnis von Belastung und Belastbarkeit auf der Basis von Fehlstellungen oder Vorschädigungen (z.B. Knorpelschädigungen).
Davon abzugrenzen sind Funktionsstörungen, die strukturell und mit bildgebenden Verfahren meist nicht zu erfassen sind. Dies gilt zum Beispiel für eine Blockade des Iliosakralgelenks (ISG) am unteren Rücken oder für die chronische Instabilität des oberen Sprunggelenks. Beim betroffenen Sportler kommt es zu Dysfunktionen, Unsicherheiten (zum Beispiel ein Gefühl der Instabilität) – auch können Schmerzen auftreten.
Risikofaktoren
Die Ursachen von Verletzungen, Über- und Fehlbelastungen sowie Funktionsstörungen sind vielfältig. Ein genereller Faktor ist sicherlich die hohe Zahl an Wettkämpfen in dichter Abfolge, die in den letzten Jahren stark gestiegen ist – parallel zur Steigerung des Spieltempos. Es können äußere, innere und sonstige Risikofaktoren unterschieden werden:
Äußere Risikofaktoren
Zu den äußeren Risikofaktoren gehören die typischen Bewegungsabläufe im Fußball mit Gegnerkontakt. Eine geschickte Zweikampfführung kann helfen, Verletzungen zu vermeiden. Die Ausrüstung mit dem richtigen Schuhwerk, das an die jeweiligen Bodenverhältnisse angepasst ist, und Schienbeinschonern gehören ebenso zu den beeinflussbaren äußeren Risikofaktoren wie andere individuell anzupassende Hilfsmittel wie Bandagen, Tapes oder Orthesen.
Innere Risikofaktoren
Die inneren Risikofaktoren sind nicht sämtlich zu beeinflussen. Es sind dies:
- Genetische Faktoren und individueller Körperbau (zum Beispiel Bindegewebsqualität; Knochenbau)
- Anatomische und funktionelle Faktoren (unter anderem Fehlstellungen; Gliedmaßenlänge; Hebelarme; Körperzusammensetzung; Hypo- und Hypermobilität der Gelenke; Störungen des Roll-Gleitmechanismus’ der Gelenke)
- Geschlecht (Frauen sind häufiger verletzt als Männer)
- Alter (ältere Spieler sind häufiger verletzt als jüngere Spieler)
- Trainingszustand (besser trainierte Spieler sind weniger häufig verletzt)
- Belastungsbedingte Ermüdung mit reduzierter neuromuskulärer Kontrolle – nicht rechtzeitiges Auswechseln (zentralnervöse und periphere Ermüdung)
- Vorherige und aktuelle Erkrankungen (unter anderem Infektionen; Zahnstatus)
- Vorherige Verletzungen (erhöhen das Risiko, sich wieder zu verletzen)
- Übertrainingszustand; mangelhafte Regeneration (erschöpfte Spieler sind anfälliger für Verletzungen)
- Psychische Verfassung (Stressfaktoren erhöhen das Verletzungsrisiko)
- Medikamenteneinflüsse (unter anderem Schmerz- und Entzündungshemmer)
Sonstige Risikofaktoren
- Fehlende oder nicht valide Screening-Verfahren (internistische, orthopädische und physiotherapeutische Screening-Verfahren)
- Suboptimale fachliche Kompetenz im Betreuerstab
- Persönlichkeitstypus mit individueller Risikoorientierung (unter anderem Kontrollüberzeugungen)
- Schicksalhafte Umstände (nicht zu antizipierende Gewalteinwirkungen)
Präventive Aspekte
Prävention im Fußballsport ist ein komplexer Gegenstandsbereich und multidisziplinär zu bearbeiten. Der Fokus darf dabei nicht nur auf physiologische, psychische und mechanische Belastungen gerichtet werden. Die Ursachen von Verletzungen, Fehl- und Überlastungen sowie von funktionellen Störungen sind multifaktoriell. Und sie sind unter anderem auch beeinflusst durch Aspekte des Lebensregimes, der Ernährung, der Trainings- und Spielbelastung sowie der gezielten Regeneration.
Risikofaktoren und Mikrotraumen müssen identifiziert und das Auftreten von Symptomen wie Koordinations- und Technikverluste oder auch geringe Schmerzen sensibel erfasst werden. Mit dem Ziel, schwerwiegende Verletzungen – soweit sie nicht schicksalhaft begründet sind – zu vermeiden (Abbildung 1).
Abb.1: Risikofaktoren, Symptome und die Folgen.
Über den Autor:
Prof. Dr. Jürgen Freiwald ist Leiter des Arbeitsbereichs Bewegungs- und Trainingswissenschaft am Institut für Sportwissenschaft der Bergischen Universität Wuppertal. In der Fußball-Bundesliga war der Sportwissenschaftler unter anderem bei Hannover 96 und Schalke 04 als Koordinator für Leistungsdiagnostik, Konditionstraining, Prävention und Rehabilitation tätig. In der Prävention und Rehabilitation von Sportlern ist er ausgewiesener Experte, was durch vielfältige nationale und internationale Publikationen unterlegt ist.
Literatur
- Freiwald, J., Rehabilitation von Sportverletzungen – Return to Sport: Ansätze und Konzepte aus sportwissenschaftlicher Perspektive. 2012: Berlin.
- Poulos, C.C., et al., The perceptions of professional soccer players on the risk of injury from competition and training on natural grass and 3rd generation artificial turf. BMC Sports Sci Med Rehabil, 2014. 6(1): p. 11.
- Williams, J.H., E. Akogyrem, and J.R. Williams, A Meta-Analysis of Soccer Injuries on Artificial Turf and Natural Grass. Journal of Sports Medicine, 2013. 2013: p. 1-6.
- Dvorák, J. and A. Junge, eds. F-MARC. Football Medicine Projects. 2006, FI-FA: Zürich.
- Dvorák, J. and A. Junge, eds. F-MARC. Fußballmedizin Manual. 2006, FIFA: Zürich.
- Lensch, J.F., Auswirkungen einer verkürzte Winterpause auf die Verletzungshäufigkeit und Verletzungsschwere im deutschen Profifußball, in Universität des Saarlandes. 2012, Universität des Saarlandes: Homburg/Saar.
- Rossler, R., et al., Soccer Injuries in Players Aged 7 to 12 Years: A Descriptive Epidemiological Study Over 2 Seasons. Am J Sports Med, 2016. 44(2): p. 309-17.
- Fuller, C.W., et al., ‘FIFA 11 for Health’ for Europe. 1: Effect on Health Know-ledge and Well-being of 10- to 12-Year-Old Danish School Children. Br J Sports Med, 2016.
- van der Horst, N., et al., The Preventive Effect of the Nordic Hamstring Exerci-se on Hamstring Injuries in Amateur Soccer Players: A Randomized Controlled Trial. Am J Sports Med, 2015.
- Tscholl, P.M., et al., High Prevalence of Medication Use in Professional Foot-ball Tournaments Including the World Cups Between 2002 and 2014: A Narrative Review With a Focus on NSAIDs. Br J Sports Med, 2015. 49(9): p. 580-2.
- McCall, A., et al., Injury Risk Factors, Screening Tests and Preventative Stra-tegies: A Systematic Review of the Evidence that Underpins the Perceptions and Practices of 44 Football (Soccer) Teams rom Various Premier Leagues. Br J Sports Med, 2015. 49(9): p. 583-9.
- McCall, A., et al., Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues. Br J Sports Med, 2014. 48(18): p. 1352-7.
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